You all know I love Centering Pregnancy. My involvement recently has been limited due to work schedules but I'm hoping to do at least a little co-facilitating soon. Watching this video got me so excited about getting back into Centering land! I can personally attest to the fact that Centering becomes a fun part of the week that I think everyone involved really looks forward to.
Check out what Centering providers, patients, and one of Centering's founders think about the model, and what it can do for perinatal outcomes:
Showing posts with label centeringpregnancy. Show all posts
Showing posts with label centeringpregnancy. Show all posts
Friday, December 23, 2011
Monday, May 23, 2011
Home birth on the rise in the U.S.
When I heard Eugene Declercq speak at the CIMS forum, I jotted down some notes on his data, but it was one of those "scribble it on the back of the conference program because you forgot to bring a notepad" situations, and he talked about so much interesting stuff I didn't have room or time to write it all down. One thing I was intrigued by was his statement that 1% of all births to white women are now happening at home. That seemed high to me, but he co-authored a new article out in the journal Birth, and it has that statistic plus a lot more info.
Some excerpts that were particularly interesting to me:
These make me think about the highly culturally specific nature of the homebirth movement in the U.S. White women (in states with small minority populations) are accessing, promoting, and creating change around homebirth, and I would say I see a culture of normalcy arising around out-of-hospital birth in a certain segment of the population. (Overheard outside a prenatal yoga class: "Well, you don't have to pack a bag since you'll be staying at home, but what are YOU packing to bring to the birth center?") There is clearly a lot of privilege at work here...there are so very very few voices speaking to the non-educated-middle-class-white-woman demographic. I often think some of the Hispanic women I work with in CenteringPregnancy would be interested in having their babies in a setting other than the hospital - out-of-hospital birth with midwives being the standard in many countries they/their families come from - but there is simply no way for them to even know that homebirth is possible in the U.S., much less sort through the complicated process of finding and accessing it, insurance-wise. (And I can't pitch homebirth to them in my role, unfortunately!)
It comes back to my frustration that the people with privilege seek out the nurturing, mother-friendly, midwifery care; and the people who need that care the most, so frequently get a prenatal care through a health department or community health center, every visit with a different provider and then labor and delivery with another set of strangers, usually the general OB service at the hospital. I see basically zero outreach to low-income/minority communities from the birth community, and walking my delicate line between working in the system right now, I am guilty of that too. How do we fix this??
Some excerpts that were particularly interesting to me:
Large differences occurred in the percentage of home births by maternal race and ethnicity, and these differences widened over time... In 2008, 1.02 percent of births to non-Hispanic white women were home births, representing a 28 percent increase from 2004, when 0.80 percent of births to non-Hispanic white women were home births. In contrast, the percentage of home births declined slightly for non-Hispanic black women from 0.30 percent in 2004 to 0.28 percent in 2008. In 2008, the percentage of home births was 0.20 for Hispanic women and 0.38 for American Indian women, statistically unchanged from the 2004 figures. In 2008, the percentage of home births was 0.27 for Asian or Pacific Islander women, up from 0.24 percent in 2004. Approximately 94 percent of the increase in the overall percentage of home births from 2004 to 2008 was because of the increase for non-Hispanic white women. In 2008, 83 percent of home births were to non-Hispanic white women, compared with 54 percent of hospital births. [emphasis mine]
In 2008, Montana had the highest percentage of home births (2.18%), followed by Vermont (1.96%) and Oregon (1.91%). Three other states (Alaska, Pennsylvania, and Wisconsin) had a percentage of home births of 1.50 percent or above. An additional 10 states had 1.00 to 1.49 percent of home births. In contrast, 18 states had less than 0.50 percent of home births.
Interestingly, the recent increase in home births in the United States began before the release of a series of documentaries and newspaper articles about home birth... Such a development is not without precedent. In the United Kingdom, a government-endorsed movement called Changing Childbirth has been credited with leading to a growth in home births that has continued until the present. However, the home birth rate in the United Kingdom had already been increasing for five consecutive years before Changing Childbirth came into being... Women choosing home birth may be a harbinger, as much as a result, of increased activism related to childbirth...
These make me think about the highly culturally specific nature of the homebirth movement in the U.S. White women (in states with small minority populations) are accessing, promoting, and creating change around homebirth, and I would say I see a culture of normalcy arising around out-of-hospital birth in a certain segment of the population. (Overheard outside a prenatal yoga class: "Well, you don't have to pack a bag since you'll be staying at home, but what are YOU packing to bring to the birth center?") There is clearly a lot of privilege at work here...there are so very very few voices speaking to the non-educated-middle-class-white-woman demographic. I often think some of the Hispanic women I work with in CenteringPregnancy would be interested in having their babies in a setting other than the hospital - out-of-hospital birth with midwives being the standard in many countries they/their families come from - but there is simply no way for them to even know that homebirth is possible in the U.S., much less sort through the complicated process of finding and accessing it, insurance-wise. (And I can't pitch homebirth to them in my role, unfortunately!)
It comes back to my frustration that the people with privilege seek out the nurturing, mother-friendly, midwifery care; and the people who need that care the most, so frequently get a prenatal care through a health department or community health center, every visit with a different provider and then labor and delivery with another set of strangers, usually the general OB service at the hospital. I see basically zero outreach to low-income/minority communities from the birth community, and walking my delicate line between working in the system right now, I am guilty of that too. How do we fix this??
Friday, January 14, 2011
Defensive medicine and the c-section assembly line
Apologies for the long posting silence. I have so many drafts in progress. In the meantime, I want to direct people to the excellent and thought-provoking posts and comments at the Unnecesarean's series Defending Ourselves Against Defensive Medicine.
I thought I would tell a little story to go with it. My last CenteringPregnancy group had their reunion today. The midwife organizes it so that the reunion takes place at the meeting of a group who is about to have their babies. Then the new moms can share their experiences of birth, breastfeeding, and baby care with the moms-to-be.
One of the reunion moms had quite the story. She had 3 days of labor and was finally at the hospital making very slow progress with a posterior baby. The midwife who facilitated the group was working with her and the doctor came in to tell the midwife that the woman should have a c-section.
The midwife took him out into the hallway to discuss it. Turns out he had a morbidly obese patient who was also going to need a c-section, and would need the OR and a number of staff for a significant amount of time. The doctor's take was, "Let's get this one out of the way, then we'll do the more complicated surgery." The midwife went to bat and said "No. Mom is fine and baby is fine. I know my patient is stalled, but you do this longer surgery and THEN, if she's still not progressed, you can take her to the OR." They argued and (thankfully!) the midwife won. She went back in and put mom in a knee chest position (keep in mind this was a mom who had an epidural! these positions are possible under many circumstances!) The baby rotated to OA, and after that labor progressed and baby was born easily.
Thank goodness for guardian midwives in the face of not just defensive but assembly-line medicine.
I thought I would tell a little story to go with it. My last CenteringPregnancy group had their reunion today. The midwife organizes it so that the reunion takes place at the meeting of a group who is about to have their babies. Then the new moms can share their experiences of birth, breastfeeding, and baby care with the moms-to-be.
One of the reunion moms had quite the story. She had 3 days of labor and was finally at the hospital making very slow progress with a posterior baby. The midwife who facilitated the group was working with her and the doctor came in to tell the midwife that the woman should have a c-section.
The midwife took him out into the hallway to discuss it. Turns out he had a morbidly obese patient who was also going to need a c-section, and would need the OR and a number of staff for a significant amount of time. The doctor's take was, "Let's get this one out of the way, then we'll do the more complicated surgery." The midwife went to bat and said "No. Mom is fine and baby is fine. I know my patient is stalled, but you do this longer surgery and THEN, if she's still not progressed, you can take her to the OR." They argued and (thankfully!) the midwife won. She went back in and put mom in a knee chest position (keep in mind this was a mom who had an epidural! these positions are possible under many circumstances!) The baby rotated to OA, and after that labor progressed and baby was born easily.
Thank goodness for guardian midwives in the face of not just defensive but assembly-line medicine.
Thursday, November 18, 2010
A breastfeeding support home visit
The last Centering Pregnancy group I co-facilitated, the other co-fac was an experienced LC. Between the two of us, we told the midwife that she should let us know when the moms in the group deliver and we would help them with breastfeeding if they need it. Unfortunately, they deliver at a different hospital in town (not the one where I work) where lactation support is extremely minimal. That hospital also tells moms things like "Just let her cry, she'll figure it out eventually" and "Don't feed your baby more often than every 3 hours" and "Don't let them nurse more than 30 minutes". As you can imagine, a lot of breastfeeding problems result... not to mention jaundice readmits.
One of our Centering moms had help from the midwife at the hospital (including her jaundice readmit), and from the LC once at home. Baby would not latch consistently, and the LC e-mailed me today to say that she thought things had been going better but she had just found out they weren't. She was booked. Could I see this mom today?
It was good timing - I didn't work last night - so I called the mom and headed over. Pulling in to the apartment complex and going into her apartment was a total flashback to my AmeriCorps days* - three immigrant families packed into a single apartment, each with one bedroom of their own. The bedroom was even just like I remembered, cramped with a big TV in the corner.**
We spent a long time working on feeding, pumping, and talking about our plan. She has two problems - getting her baby to latch and maintaining a supply with just a hand pump (which wasn't getting used often enough). This mom told me her goal is "puro pecho" which if you've read my "los dos" post, you know isn't always the case with Hispanic moms! I am so determined to help her reach her goal - she is a committed mom who has been persistent where other people would have given up.
Still, it made me discouraged. A more privileged mom would hopefully have the education and resources to quickly identify breastfeeding problems and feel entitled to help; she would be able to hire a private lactation consultant to make multiple home visits; she would be able to rent a hospital-grade pump to maximize her supply.
This mom happened to do Centering and happened to have for facilitators two LCs with extra time on their hands. What about all the dozens and hundreds of other moms in her situation, who we don't know and can't see? In many other counties, I could refer her to a WIC peer counselor; her county's WIC has none and doesn't seem interested in getting any. At best she might be able to get a better pump from WIC (which she didn't realize - I knew to call and ask.) If not for the very rare happenstance of hands-on support, she'd just be left to struggle on her own, offering a screaming baby the breast 8 times a day and using the hand pump she got in the hospital to get what she can.
This is breastfeeding support in our country, to the most vulnerable moms who need help the most. This is why we need to talk about the public health risks of seeing formula as a perfectly good fall-back. This is totally unfair to mothers who WANT to breastfeed, who are working hard to breastfeed, and who do not have the resources to get the help they deserve.
*Bonus AmeriCorps story: Our supervisor did not love us doing home visits - you wouldn't either, if you were an experienced midwife with strong maternal instincts, in charge of a group of naive but enthusiastic young women. She approved home visits only in very specific circumstances and with lots of warnings. We also had to call when we got there and call when we left safely. Like I said, strong maternal instincts. So one of my teammates and I went to do a home visit one day after lots of dire warnings and promising to call. We are primed to be cautious. We get there and it's just mom and baby home. We start helping her... and her boyfriend walks in just home from work - with a six-pack of beer. Immediately we both get a little anxious. This is what our supervisor was most concerned about - boyfriends/husbands/other men around who would give us a hard time or see us as a target. We're having trouble getting the baby latched (all the while keeping one eye on the guy doing stuff in the kitchen) and we suggest to mom that she pump a little to get the milk flowing. Her boyfriend leaps into action, assembling the breastpump, bringing it to her, and then sits beside her, asking us a lot of concerned questions about how the baby is feeding. So much for our paranoid fantasies!
**For a long time I wondered about that - how could people only have enough money for one bedroom, but still enough to have a huge expensive TV? - until one of my AmeriCorps teammates explained to me that buying expensive electronics was how many people in South American countries keep liquid assets. Think about it - if you don't or can't get a bank account, how can you make sure you can get cash if you need it, without actually keeping all that cash on hand? One way is to buy something that will be easy to re-sell quickly. It's not a great investment, because it will depreciate instead of appreciate, but people only have so many options. I really appreciate the work that community-based organizations and credit unions do to help teach people about banking and make those options more accessible.
One of our Centering moms had help from the midwife at the hospital (including her jaundice readmit), and from the LC once at home. Baby would not latch consistently, and the LC e-mailed me today to say that she thought things had been going better but she had just found out they weren't. She was booked. Could I see this mom today?
It was good timing - I didn't work last night - so I called the mom and headed over. Pulling in to the apartment complex and going into her apartment was a total flashback to my AmeriCorps days* - three immigrant families packed into a single apartment, each with one bedroom of their own. The bedroom was even just like I remembered, cramped with a big TV in the corner.**
We spent a long time working on feeding, pumping, and talking about our plan. She has two problems - getting her baby to latch and maintaining a supply with just a hand pump (which wasn't getting used often enough). This mom told me her goal is "puro pecho" which if you've read my "los dos" post, you know isn't always the case with Hispanic moms! I am so determined to help her reach her goal - she is a committed mom who has been persistent where other people would have given up.
Still, it made me discouraged. A more privileged mom would hopefully have the education and resources to quickly identify breastfeeding problems and feel entitled to help; she would be able to hire a private lactation consultant to make multiple home visits; she would be able to rent a hospital-grade pump to maximize her supply.
This mom happened to do Centering and happened to have for facilitators two LCs with extra time on their hands. What about all the dozens and hundreds of other moms in her situation, who we don't know and can't see? In many other counties, I could refer her to a WIC peer counselor; her county's WIC has none and doesn't seem interested in getting any. At best she might be able to get a better pump from WIC (which she didn't realize - I knew to call and ask.) If not for the very rare happenstance of hands-on support, she'd just be left to struggle on her own, offering a screaming baby the breast 8 times a day and using the hand pump she got in the hospital to get what she can.
This is breastfeeding support in our country, to the most vulnerable moms who need help the most. This is why we need to talk about the public health risks of seeing formula as a perfectly good fall-back. This is totally unfair to mothers who WANT to breastfeed, who are working hard to breastfeed, and who do not have the resources to get the help they deserve.
*Bonus AmeriCorps story: Our supervisor did not love us doing home visits - you wouldn't either, if you were an experienced midwife with strong maternal instincts, in charge of a group of naive but enthusiastic young women. She approved home visits only in very specific circumstances and with lots of warnings. We also had to call when we got there and call when we left safely. Like I said, strong maternal instincts. So one of my teammates and I went to do a home visit one day after lots of dire warnings and promising to call. We are primed to be cautious. We get there and it's just mom and baby home. We start helping her... and her boyfriend walks in just home from work - with a six-pack of beer. Immediately we both get a little anxious. This is what our supervisor was most concerned about - boyfriends/husbands/other men around who would give us a hard time or see us as a target. We're having trouble getting the baby latched (all the while keeping one eye on the guy doing stuff in the kitchen) and we suggest to mom that she pump a little to get the milk flowing. Her boyfriend leaps into action, assembling the breastpump, bringing it to her, and then sits beside her, asking us a lot of concerned questions about how the baby is feeding. So much for our paranoid fantasies!
**For a long time I wondered about that - how could people only have enough money for one bedroom, but still enough to have a huge expensive TV? - until one of my AmeriCorps teammates explained to me that buying expensive electronics was how many people in South American countries keep liquid assets. Think about it - if you don't or can't get a bank account, how can you make sure you can get cash if you need it, without actually keeping all that cash on hand? One way is to buy something that will be easy to re-sell quickly. It's not a great investment, because it will depreciate instead of appreciate, but people only have so many options. I really appreciate the work that community-based organizations and credit unions do to help teach people about banking and make those options more accessible.
Monday, July 12, 2010
Looking back at Centering Pregnancy
Donna at Banned from Baby Showers writes about her excitement that CenteringPregnancy is coming to her area. (You can read a description of Centering in her post, and learn more about the model at the Centering website.) That reminded me that I just finished the last visit for the Centering group I have been co-faciitating and have been wanting to write a post about the experience.
The group I worked with was led by a CNM, and co-facilitated with me and one other volunteer. (Like Donna mentioned, Centering was started by, and is most often facilitated by midwives, and is a great example of a midwifery model of care. However, I do know of family practice docs and OBs in our area who do Centering!) She was fabulous, an experienced Centering facilitator. My first vision of Centering was that a woman would ask a question, and the midwife would answer it so everyone could hear it and learn together. Instead, a woman would ask a question, and the midwife would turn it right around. "Oh, what helps with leg cramps? What's good for leg cramps, everyone? What do you do?" Oftentimes she never even gave her own answer to a question - the group did, finding their own answers and gaining confidence in the process.
She was also a real midwife, not shy about bringing up potentially delicate topics. "I have trouble sleeping," someone would say. She would turn the question back around to the group, and then at the end of all the suggestions she would say "And...sex?" (It was actually a Spanish-speaking group so she would say "Y...el sexo?" which somehow was even funnier). I thought all these shy Hispanic ladies would just turn beet red and clam up - especially in the presence of their boyfriends/husbands - but instead everyone started talking. "But what if you don't want it? What if you do - how much is too much? What if you don't want him to even TOUCH you?" It was pretty funny and great to watch.
I kept wondering, in my didactic mindset, "When are we going to teach about birth?" I was all ready to break out the Childbirth Graphics posters. Instead, the midwife took the group on a hospital tour. She walked them through the halls and we took over a birthing room. We fetched birth balls and had the women try sitting on them. We got a squat bar and the midwife got up on the bed and got one of the women to pretend to catch her baby in different positions. She told us that the nurses know when a Centering mom is checking in because "She asks for a lot of stuff!" We had a reunion visit with another group whose babies were several months old, and they talked about requesting birth balls and how nice they were to labor on. I also discovered that the women in our group didn't know that they could decline to have students in their room, and we talked about the power they had to make decisions over what happened to them in their health care.
The women in the group were lovely. It was a fairly quiet group, but we had some nice discussions (not just about sex!) I did the reminder phone calls for each visit, and they started to recognize my number and answer the phone with "Bueno, Rebecca?" They had a lot of struggles - partners working far away, one deported while the group was happening, trouble finding work, difficulty navigating a new country and an unfamiliar language. But they were always so gracious and appreciative.
At the end of the last visit, we all stood in a circle. The midwife took a ball of yarn and wrapped the end around her wrist. She tossed it to the next person, who had to wrap the yarn around their wrist twice and say an appreciation for the group, or wish for the group. One of the women thanked the facilitators for taking the time to help them, because she felt like most people in the U.S. didn't. Another thanked the midwife for the personal care and attention, and said she was only sorry that this was the first time she was experiencing it, during her last pregnancy. At the end we were all linked by overlapping strings of yarn. We each cut the yarn close to our wrists and tied it up, a little blessing-bracelet from the group.
It was sad to say good-bye! There were a lot of hugs. I'm so excited for each person to have their babies, and to see them at the reunion visit in a couple of months. It really has been such a great experience. I'm already looking for another group to join. (Although another co-faciliator told me "Watch out, Centering can be habit-forming.")
If you can choose Centering care for your pregnancy, I highly encourage it! If you're interested in working with Centering groups, see if there are any in the area that need assistance. The Centering program I've been volunteering with depends hugely on volunteers as co-facilitators - it is based out of a community health center with minimal resources.
And just in case you don't catch this on the Centering website, Centering decreases preterm birth rates and increases breastfeeding rates. All this touchy-feely stuff isn't just touchy-feely - it is evidence-based and improving outcomes. And I really believe based on what I've seen that Centering helps women take control of their health care and be better self-advocates. I hope to write more soon about the Centering module I've been developing on health disparities - but that's another project for another day...
Edited to add: Amy Romano of Science and Sensibility mentioned in the comments that she recently wrote an article for RH Reality Check on how Centering can reduce our infant mortality disparities. Check it out!
The group I worked with was led by a CNM, and co-facilitated with me and one other volunteer. (Like Donna mentioned, Centering was started by, and is most often facilitated by midwives, and is a great example of a midwifery model of care. However, I do know of family practice docs and OBs in our area who do Centering!) She was fabulous, an experienced Centering facilitator. My first vision of Centering was that a woman would ask a question, and the midwife would answer it so everyone could hear it and learn together. Instead, a woman would ask a question, and the midwife would turn it right around. "Oh, what helps with leg cramps? What's good for leg cramps, everyone? What do you do?" Oftentimes she never even gave her own answer to a question - the group did, finding their own answers and gaining confidence in the process.
She was also a real midwife, not shy about bringing up potentially delicate topics. "I have trouble sleeping," someone would say. She would turn the question back around to the group, and then at the end of all the suggestions she would say "And...sex?" (It was actually a Spanish-speaking group so she would say "Y...el sexo?" which somehow was even funnier). I thought all these shy Hispanic ladies would just turn beet red and clam up - especially in the presence of their boyfriends/husbands - but instead everyone started talking. "But what if you don't want it? What if you do - how much is too much? What if you don't want him to even TOUCH you?" It was pretty funny and great to watch.
I kept wondering, in my didactic mindset, "When are we going to teach about birth?" I was all ready to break out the Childbirth Graphics posters. Instead, the midwife took the group on a hospital tour. She walked them through the halls and we took over a birthing room. We fetched birth balls and had the women try sitting on them. We got a squat bar and the midwife got up on the bed and got one of the women to pretend to catch her baby in different positions. She told us that the nurses know when a Centering mom is checking in because "She asks for a lot of stuff!" We had a reunion visit with another group whose babies were several months old, and they talked about requesting birth balls and how nice they were to labor on. I also discovered that the women in our group didn't know that they could decline to have students in their room, and we talked about the power they had to make decisions over what happened to them in their health care.
The women in the group were lovely. It was a fairly quiet group, but we had some nice discussions (not just about sex!) I did the reminder phone calls for each visit, and they started to recognize my number and answer the phone with "Bueno, Rebecca?" They had a lot of struggles - partners working far away, one deported while the group was happening, trouble finding work, difficulty navigating a new country and an unfamiliar language. But they were always so gracious and appreciative.
At the end of the last visit, we all stood in a circle. The midwife took a ball of yarn and wrapped the end around her wrist. She tossed it to the next person, who had to wrap the yarn around their wrist twice and say an appreciation for the group, or wish for the group. One of the women thanked the facilitators for taking the time to help them, because she felt like most people in the U.S. didn't. Another thanked the midwife for the personal care and attention, and said she was only sorry that this was the first time she was experiencing it, during her last pregnancy. At the end we were all linked by overlapping strings of yarn. We each cut the yarn close to our wrists and tied it up, a little blessing-bracelet from the group.
It was sad to say good-bye! There were a lot of hugs. I'm so excited for each person to have their babies, and to see them at the reunion visit in a couple of months. It really has been such a great experience. I'm already looking for another group to join. (Although another co-faciliator told me "Watch out, Centering can be habit-forming.")
If you can choose Centering care for your pregnancy, I highly encourage it! If you're interested in working with Centering groups, see if there are any in the area that need assistance. The Centering program I've been volunteering with depends hugely on volunteers as co-facilitators - it is based out of a community health center with minimal resources.
And just in case you don't catch this on the Centering website, Centering decreases preterm birth rates and increases breastfeeding rates. All this touchy-feely stuff isn't just touchy-feely - it is evidence-based and improving outcomes. And I really believe based on what I've seen that Centering helps women take control of their health care and be better self-advocates. I hope to write more soon about the Centering module I've been developing on health disparities - but that's another project for another day...
Edited to add: Amy Romano of Science and Sensibility mentioned in the comments that she recently wrote an article for RH Reality Check on how Centering can reduce our infant mortality disparities. Check it out!
Sunday, March 14, 2010
A cold wind blows...for breastfeeding!
The next CenteringPregnancy visit that I am co-facilitating is coming up next week. As always, I am really looking forward to it! One of the topics for this week is breastfeeding, and of course I am assigned to run that section. I was talking to the midwife who runs the group for ideas, and she said that in the past she's done a "Red Rover" style game - "Let anyone who's ever breastfed a baby come over", for example, and then ask those women what their experiences were - a fun way to get people talking.
Our room is very small, though, so I suggested "A Cold Wind Blows" using the same concept. In that game, there's a circle of chairs, with one less chair than people. The idea is that I'll say "A cold wind blows for everyone who's ever breastfed a baby" and then everyone who has breastfed has to get up and find a new chair - only one person is left standing. Then they get a question like "How did breastfeeding go?" and you can also ask people who you noticed get up and find a new seat. These women aren't hugely pregnant yet, so I'm hoping it won't be too crazy an idea, but we'll see!
I'm brainstorming ideas for "cold winds". Here are my ideas so far (with their Spanish translations, since this is a Spanish group):
Everyone who has ever:
- Breastfed a baby/Dado pecho a su bebe
If there are enough people who have breastfed, we can follow up with:
- Had pain from breastfeeding/Tenido dolor de dar pecho?
- Breastfed after going back to work/Seguido dando pecho despues de regresar al trabajo?
- Breastfed for a year or more/Dado pecho un año o mas?
- Had problems with making enough milk/Tenido problemas con producir suficiente leche?
- Gotten help for a breastfeeding problem/Recibido ayuda para resolver una problema con la lactancia?
All of these questions can be followed up with questions about what were problems/advantages/solutions, etc.
- Has a sister or friend who breastfed/Tenido una hermana o amiga que le dio pecho a su bebe?
Follow-up question: What did she tell you about breastfeeding/Que le ha dicho sobre dar el pecho? (Following discussion could go a lot of ways depending on response - also a way to elicit conversation about problems if we don't have enough people who breastfed in the group.)
- Is planning to buy a breast pump/Va a comprar una pompa para sacar la leche?
Follow-up question: When are you planning to use it, and for what/Cuando la va a usar, y para que?
- Heard something good about breastfeeding? Heard something bad?
Follow-up question: What did you hear? (More opportunities to talk about both benefits and problems!)
These questions may entail enough running-around time for moderately-pregnant women, and then we can move into just sitting and discussing! But does anybody have other ideas? (Or comments on my Spanish translations, imperfect as I'm sure they are.)
Note: in one randomized controlled trial, women who participated in CenteringPregnancy were significantly more likely to initiate breastfeeding than those who had been assigned to individual care (66.5% vs. 54.6%; odds ratio 1.73, confidence interval: 1.28-2.35). I'm hoping they used "A cold wind blows" in that trial too.
Our room is very small, though, so I suggested "A Cold Wind Blows" using the same concept. In that game, there's a circle of chairs, with one less chair than people. The idea is that I'll say "A cold wind blows for everyone who's ever breastfed a baby" and then everyone who has breastfed has to get up and find a new chair - only one person is left standing. Then they get a question like "How did breastfeeding go?" and you can also ask people who you noticed get up and find a new seat. These women aren't hugely pregnant yet, so I'm hoping it won't be too crazy an idea, but we'll see!
I'm brainstorming ideas for "cold winds". Here are my ideas so far (with their Spanish translations, since this is a Spanish group):
Everyone who has ever:
- Breastfed a baby/Dado pecho a su bebe
If there are enough people who have breastfed, we can follow up with:
- Had pain from breastfeeding/Tenido dolor de dar pecho?
- Breastfed after going back to work/Seguido dando pecho despues de regresar al trabajo?
- Breastfed for a year or more/Dado pecho un año o mas?
- Had problems with making enough milk/Tenido problemas con producir suficiente leche?
- Gotten help for a breastfeeding problem/Recibido ayuda para resolver una problema con la lactancia?
All of these questions can be followed up with questions about what were problems/advantages/solutions, etc.
- Has a sister or friend who breastfed/Tenido una hermana o amiga que le dio pecho a su bebe?
Follow-up question: What did she tell you about breastfeeding/Que le ha dicho sobre dar el pecho? (Following discussion could go a lot of ways depending on response - also a way to elicit conversation about problems if we don't have enough people who breastfed in the group.)
- Is planning to buy a breast pump/Va a comprar una pompa para sacar la leche?
Follow-up question: When are you planning to use it, and for what/Cuando la va a usar, y para que?
- Heard something good about breastfeeding? Heard something bad?
Follow-up question: What did you hear? (More opportunities to talk about both benefits and problems!)
These questions may entail enough running-around time for moderately-pregnant women, and then we can move into just sitting and discussing! But does anybody have other ideas? (Or comments on my Spanish translations, imperfect as I'm sure they are.)
Note: in one randomized controlled trial, women who participated in CenteringPregnancy were significantly more likely to initiate breastfeeding than those who had been assigned to individual care (66.5% vs. 54.6%; odds ratio 1.73, confidence interval: 1.28-2.35). I'm hoping they used "A cold wind blows" in that trial too.
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